Complications of A Heart Attack
A person who has a heart attack may experience any of these complications: myocardial rupture, blood clots, irregular heartbeats (arrhythmias), heart failure or shock, or pericarditis.
Myocardial Rupture
Because damaged heart muscle is weak, it sometimes ruptures under the pressure of the heart's pumping action. Two parts of the heart are particularly susceptible to rupture during or after a heart attack: the heart muscle wall and the muscles that control the opening and closing of one of the heart's valves-the mitral valve. If these muscles rupture, the valve can't function-the result is sudden and severe heart failure.
The heart muscle may rupture in the wall separating the two ventricles (septum) or on the external heart wall. Although ruptures of the septum can sometimes be repaired surgically, ruptures of the external heart wall almost always lead to rapid death.
More often, heart muscle damaged by a heart attack doesn't contract properly even if it isn't torn or ruptured. The damaged muscle is replaced by tough, fibrous scar tissue that contracts very little or not at all. Sometimes part of the heart wall expands or bulges when it should contract. Angiotensin converting enzyme (ACE) inhibitors can reduce the extent of these abnormal areas.
The damaged muscle may form a thin bulge (aneurysm) on the heart wall. A doctor may suspect an aneurysm from an abnormal electrocardiogram (ECG) pattern but needs to use an echocardiogram to be sure. These aneurysms don't rupture, but they may cause episodes of irregular heartbeats and may diminish the heart's pumping ability. Because blood flows more slowly through aneurysms, blood clots can form in the heart's chambers.
Blood Clots
Clots form in the heart in 20 to 60 percent of people who've had a heart attack. In about 5 percent of these people, parts of the clots can break off, travel through the arteries, and lodge in smaller blood vessels throughout the body, blocking the blood supply to part of the brain (causing a stroke) or to other organs. An echocardiogram may be taken to detect clots forming in the heart or to see if a person has predisposing factors, such as an area of the heart's left ventricle that isn't beating as well as it should. Doctors often prescribe anticoagulants such as heparin and warfarin to help prevent clot formation. These medications are usually taken for 3 to 6 months after a heart attack.
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